A new breed of ethicist

Clinical ethicists prove valuable

Chances are your ethics committee has no budget for educational or resource materials or to seek professional help from consultants, and like most of your colleagues, you’re not alone.

Rather than attempting to persuade hospital administration to allocate funds in the next budget planning process, try a different approach that could yield even better results than additional money. A clinical ethicist who works full time for the hospital or health system could be the answer, and it may not be as far-fetched a possibility as you think, say ethicists who are pioneering the role.

"Our ethics committee does not have a budget, but my role within the health system is to provide leadership for the committee, offer ethics consultations, and coordinate meetings of the committee. Although there’s no budget for the committee, there is a budgeted allotment for my salary," says Bernard Hammes, PhD, clinical ethicist at Gunderson Lutheran Hospital in La Crosse, WI.

Gunderson Lutheran Hospital is part of a non-profit health system that includes a physician group practice and long-term care facility. While most of his time is spent within the hospital, he does help with consultations in physician offices and the long-term care facility, he says.

Hammes helps organize quarterly meetings for the hospitalwide ethics committee and provides consultations whenever needed. "All of the individual consultations performed between meetings are written up in a report and presented to the committee in advance before the next scheduled meeting," he adds.

The clinical ethicist position seems to be catching on. Three hospitals in Memorial Health System in Springfield, IL, for example, share a clinical ethicist who advises each committee.

"The Clinical Ethics Center has office space and secretarial assistance, and all the resources we have are shared with the three hospitals, the home health agency, and two hospitals who are affiliated with our system," says Thomas May, PhD, director of the center.

Advantages are numerous

An additional advantage to having a full-time clinical ethicist is having a dedicated staff person develop educational programs or design policies and procedures.

"There are times when the committee determines that if it feels there’s an area where staff aren’t understanding a policy or procedure, it will ask me to create an educational program to help solve the problem. A person whose job is to focus on these things helps determine how ethics plays out in daily practice," Hammes notes.

Like Hammes, May helps hospitals within the system develop policies and procedures or provide education if a new policy is implemented.

"While I’m a member of each hospital’s ethics committee, I serve more as an advisor. Each committee has a chairperson who works in the facility," May explains.

Hammes cites an scenario at his facility in which a patient was admitted to the emergency department (ED) who had requested a do-not-resuscitate (DNR) order during a prior hospital stay. The patient went into cardiac arrest before the DNR order arrived from medical records, and the patient was resuscitated.

"The question came up that if a patient does express a preference for not receiving resuscitation, how should it be carried out in the emergency department setting?" Hammes worked with the ED staff in developing a script that’s used to broach the subject of DNR without creating anxiety for the patient. "So far, based on the results from a pilot study, it seems to be working, and we’ll now determine if this should become policy," he explains.

The clinical ethicist position at Gunderson Lutheran started as a part-time position and became a full-time position two years later, says Hammes.

"This was a physician-driven project that was supposed to last for two years, and after an evaluation at the completion, administration determined it should be a full-time position," he says.

"When I started, one of the goals was to provide additional education and resources for our residents, and the hospital leaders saw how we’ve taken the education and put it into training and improved the delivery systems from an ethical standpoint."